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Health and Human Services Secretary Alex Azar. Photo: Chip Somodevilla/Getty Images

The Trump administration's recent proposal to change the way drug prices are negotiated in Medicare and Medicaid is operating under a tight timeline, and some are skeptical that it can be solidified by 2020.

Why it matters: The new policy would raise Medicare Part D premiums once it takes effect. For now, the premium hike is expected to be announced this fall. But if implementation is delayed, that hike could come in the fall of 2020 — right before the presidential election.

The big picture: The proposal would change the way drug prices are negotiated behind the scenes, phasing out the drug rebates collected by insurers and replacing them with discounts to consumers at the pharmacy counter.

  • Insurers currently use rebates to lower premiums. The new rule is expected to lower out-of-pocket costs for seniors who currently pay a lot for their drugs, but raise premiums for Medicare Part D by as much as 25% over the next decade, per the federal government's analysis.
  • While the change is expected to take place beginning in January of next year, insurance plans are developed and locked in over a rigid timeline that essentially must be completed by June.
  • "Health insurance providers are concerned over the timeline of implementing for 2020," said Kristine Grow, a spokeswomen for America's Health Insurance Plans.

Details: The public has 60 days to weigh in, which will be followed by another 60-day period for HHS to evaluate the comments. A final rule should come out around May.

  • Meanwhile, companies have to submit their drug plans by May, and final bids for Medicare drug plans have to be submitted by June. That leaves almost no time for the industry to reconcile the rule with their 2020 plans.

The bottom line: Part D premiums are heavily subsidized, but the politics of raising seniors' health care costs are never good.

  • Insurers won't be happy to find themselves in the line of fire regardless of when the changes take place.
  • Democrats would love to weaponize seniors' health care costs right ahead of the 2020 elections. And Republicans can't be excited to have that problem on their hands, though they could also see some benefit from seniors who see their costs at the pharmacy counter fall.

Go deeper

Ina Fried, author of Login
19 mins ago - Technology
Column / Signal Boost

Huawei sanctions snarled chip supply chains

Illustration: Sarah Grillo/Axios

The largely successful U.S. effort to hobble China's Huawei has benefitted a host of other tech companies — from smartphone makers such as Apple and Xiaomi to chipmakers like Qualcomm to network vendors including Nokia and Ericsson.

Yes, but: The massive disruption to the industry furthered an industry wide mismatch between supply and demand, exacerbating the global chip shortage.

Tina Reed, author of Vitals
39 mins ago - Health

Overturning Roe could strain abortion access even in blue states

The Supreme Court is reflected in a woman's sunglasses during a march Oct. 2. Photo: Andrew Caballero-Reynolds/AFP via Getty Images

If the Supreme Court overturns Roe v. Wade, abortions could be harder to access even in states where they remain legal, because those clinics could be flooded with patients from states that have cracked down.

The big picture: This has happened before, and clinics fear the crush of demand would be a major problem in the immediate wake of a decision that would allow states to ban abortion.

A critical race theory founder says he's being inundated with threats

Richard Delgado. Photo: Courtesy of Richard Delgado

Richard Delgado, one of the founders of the critical race theory movement, tells Axios he and his wife have been receiving a steady stream of threatening messages since the coordinated, conservative campaign against critical race theory began.

Why it matters: Educators across the country — even some elementary school teachers — have faced harassment and threats over the past year over lesson plans that teach about system racism in the U.S.

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